Eating disorders Flashcards
Define: REFEEDING SYNDROME
syndrome of metabolic disturbances (potential fatal shifts in fluids + electrolytes) that occur in MALNOURISHED patients receiving nutritional support/artificial referring (from any route)
Occurs within 3-4 days of refeeding
Describe pathophys of REFEEDING SYNDROME
Starvation:
low carbohydrates → ↓ insulin secretion (when fasted)
total body reserves of K, Mg, PO4, B12 are depleted, although serum levels are maintained
Refeeding with CHOs cause insulin spike ( ↑↑ secretion ) → stimulates massive uptake of PO4, K+ & Mg+ into cells = precipitous drop in serum concentrations
Cx of REFEEDING SYNDROME
- Acute cardiac failure - most important & common
- cardiac arrhythmias
- Wernicke’s encephalopathy ( acute
- Sepsis
- Acute renal failure (rhabdomyolysis → ATN)
- confusion/coma/ convulsions
Wernicke’s encephalopathy
Acute onset of Confusion, Ophthalmoplegia & Ataxia secondary to thiamine deficiency (Vit B1) and continued CHO intake
- excessive ETOH intake interferes with GI absorption of thiamine
- also occurs in other poor nutritional states
- reversible if thiamine supplementation
NB: if not reversed, then disorder can degenerate to Korsakoff’s psychosis
THINK: Wernicke wears a reversible COAt
Korsakoff’s syndrome
a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1).
- most commonly caused by alcohol misuse (↓GI absorption of thiamine, direct neurotoxic effect of EtOH)
if left untreated, 80% of pt with WE will progress to Korsakoff’s psychosis
Triad:
- Confabulation
- Amnesia ( + memory changes)
- Personality changes
NB: other conditions also can cause the syndrome
Delirium Tremans
a rapid onset of confusion usually caused by withdrawal from alcohol.
Delirium Tremans
[MEDICAL EMERGENCY]
5-20% of patients detoxing from EtOH. 1/3 of patients w withdrawal seizures.
= the most severe form of ethanol withdrawal manifested by rapid onset of:
- altered mental status (global confusion, impaired attention/consciousness)
- sympathetic overdrive (autonomic hyperactivity): tremors/↑HR/diaphoresis
- hallucinations (aud/visual/tactile)
Can progress to cardiovascular collapse. Has a high mortality rate, making early recognition and treatment essential.
What is the pattern of EtOH withdrawal symptoms?
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DSM V: BULIMIA NERVOSA
1) Eating in a discrete period of time (eg: within any 2 hr period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumtances 2) A sense of lack of control over eating during th episode (eg: cant stop eating or control how much one is eating)
Types:
• RESTRICTING: during the last 3 months, patient has not engaged in episodes of binge/purging. Weight loss though dieting, fasting and/or excessive exercising
BINGE-EATING/PURGING: during the last 3 months, recurrent self-induced vomiting or the misuse of laxatives, diuretics or enemas
Define: BULIMIA
- Episodes of binge-eating (ie: eating a large amount of food in a short period of time), followed by attempts to purge body of the food via vomiting, laxatives or excessive exercise
- Context of over concern with weight and shape
Define: ANOREXIA
• persistent energy intake restriction
• Inability to maintain minimally normal weight
• Intense fear of gaining weight
Disturbance in perception of body weight or shape
DSM 5: ANOREXIA NERVOSA
Types:
• RESTRICTING: during the last 3 months, patient has not engaged in episodes of binge/purging. Weight loss though dieting, fasting and/or excessive exercising
• BINGE-EATING/PURGING: during the last 3 months, recurrent self-induced vomiting or the misuse of laxatives, diuretics or enemas
Mx approach ANOREXIA (overview)
MDT approach coordinated among GP, psychiatrist, psychologist and dietician
Mainstay of treatment
- Psychoeducation
- nutritional rehabilitation
- psychotherapy
NB: psychotropic medications play an adjuvant role.
Treatment should always aim to include the family
Mx of ANOREXIA
MDT approach
1) restoration to healthy body weight
2) treatment of physical complications (esp if pt significantly underweight, such that they are medically compromised, re-feeding is required as a matter of urgency)
3) • enhancement of motivation to restore healthy eating patterns and engagement in treatment
4) education about healthy nutrition and eating patterns
5) psychological intervention for related maladaptive thoughts, attitudes and feelings
6) treatment of psychiatric comorbidity
7) relapse prevention.
Family based therapy
Management of REFEEDING SYNDROME
Mx:
1) PREVENTION: thiamine, vit. B complex and multivitamins/minerals is recommended
2) MONITOR BIOCHEM CLOSELY
3) use milk for refeeding as naturally high in phosphate and easily tolerated
- Oral route preferred, parenteral if severe
4) Energy intake should be 50-75% of normal for first 3-5 days
- GIT upset is common (colic, reflux, nausea, early satiety
